Basic Information
| Provider Information | |||||||||
| NPI: | 1922075886 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MORRISTOWN PATHOLOGY ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 500 | ||||||||
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| City: | HACKETTSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078400500 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MADISON AVE | ||||||||
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| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079606136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739715612 | ||||||||
| FaxNumber: | 9732907370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 05/25/2017 | ||||||||
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| AuthorizedOfficialLastName: | MAGIDSON | ||||||||
| AuthorizedOfficialFirstName: | JORY | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9739715612 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 25MF00056400 | NJ | N | Laboratories | Clinical Medical Laboratory | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 3242501 | 05 | NJ | MEDICAID |